EURURO Vol. 71 No. 5

701 844

Brief Correspondence
The Incremental Role of Magnetic Resonance Imaging for Prostate
Cancer Staging before Radical Prostatectomy
Alessandro Morlacco Vidit Sharma Boyd R. Viers Laureano J. Rangel Rachel E. Carlson
Adam T. Froemming R. Jeffrey Karnes [2_TD$DIFF]
a Department of Urology, Mayo Clinic in Rochester, MN, USA; b Department of Health Science Research, Mayo Clinic in Rochester, MN, USA; c Department of
Radiology, Mayo Clinic in Rochester, MN, USA
Prediction of adverse pathological features at surgery, in
terms of extracapsular extension (ECE), seminal vesicle
invasion (SVI), and node positivity (N+), is of particular
interest when defining the surgical approach and the role of
magnetic resonance imaging (MRI) in this setting is still a
matter of debate.
The European Association of Urology and National
Comprehensive Cancer Network guidelines do not
provide definitive indications for MRI use, simply
hypothesizing a role for this technique, especially in
high-risk disease. A recent meta-analysis concluded
that MRI has a good specificity for T staging, while
sensitivity is highly variable. As such, there remains a
high-level of clinical uncertainty regarding the potential
role of MRI, particularly when compared with conventional,
clinically-based risk classification models. In the present
study, we compared MRI with existing models (the Cancer
of the Prostate Risk Assessment [CAPRA] score and the
ava ilable at
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Article info
Article history:
Accepted August 5, 2016
Associate Editor:
Giacomo Novara
Keywords:
MRI
Staging
Risk assessment
Prostate cancer
Prostatectomy
Predictive models
CAPRA score
Partin Table
Abstract
In the present report we aimed to analyze the incremental value of preoperative
magnetic resonance imaging (MRI), in addition to clinical variables and clinically-
derived nomograms, in predicting outcomes radical prostatectomy (RP). All Mayo Clinic
RP patients who underwent preoperative 1.5-Tesla MRI with endo-rectal coil from
2003 to 2013 were identified. Clinical and histopathological variables were used to
calculate Partin estimates and Cancer of the Prostate Risk Assessment (CAPRA) score.
MRI results in terms of extracapsular extension (ECE), seminal vesicle invasion (SVI), and
lymph-node invasion (N+) were recorded. Using RP pathology as gold standard, we
developed multivariate logistic regression models based on clinical variables, Partin
Tables, and CAPRA score, and assessed their predictive accuracy before and after the
addition of MRI results. Five hundred and one patients were included. MRI + clinical
models outperformed clinical-based models alone for all outcomes. Comparing Partin
and Partin + MRI predictive models, the areas under the curve were 0.61 versus 0.73 for
ECE, 0.75 versus 0.82 for SVI, and 0.82 versus 0.85 for N+. Comparing CAPRA and CAPRA +
MRI models, the areas under the curve were 0.69 versus 0.77 for ECE, 0.75 versus 0.83 for
SVI, and 0.82 versus 0.85 for N+. Our data show that MRI can improve clinical-based
models in prediction of nonorgan confined disease, particularly for ECE and SVI.
Patient summary: Magnetic resonance imaging, together with clinical information, can
be useful in preoperative assessment before radical prostatectomy.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Mayo Clinic, Gonda Building 7-130, 200 First Street South West Rochester,
MN 55905, USA. Tel. +1-507-266-9968; Fax: +1-507-284-4951.
E-mail address: (R.J. Karnes).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.